Ask a Nurse: What Is the Novavax COVID-19 Vaccine and How Is It Different?

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The Novavax vaccine Adjuvanted is the fourth COVID-19 vaccine approved by the Food and Drug Administration (FDA) under emergency use authorization (EUA). The Novavax vaccine offers people a new option for COVID-19 protection as it triggers a different response in the body.

The Novavax biotech company applied for EUA in January 2022, and it was approved on July 13, 2022. The vaccine has been approved in 40 other countries, including Canada, under the brand names Nuvaxovid and Covovax.

The Novavax COVID vaccine uses older technology that does not impact cellular RNA or DNA, as other COVID-19 vaccines do. Rather, it uses a protein to trigger an immune response.

How Does the Novavax COVID-19 Vaccine Work?

The Novavax vaccine was developed using technology similar to past vaccines, such as the flu and diphtheria, tetanus, and pertussis vaccines. However, while those took 5-10 years to develop and fully test, the Novavax development and testing data were available within around 18 months. 

The Novavax vaccine combines the spike protein that covers the SARS-CoV-2 virus and a stimulant used to trigger an immune response against the protein shell. The immune stimulant is an adjuvant, a substance used to increase the efficacy of a drug. 

The vaccine is a two-dose series approved for people ages 18 and older. In an interview with Johns Hopkins University, William Moss from the International Vaccine Access Center lists other vaccines that use similar technology, including vaccines for:

• Human papillomavirus
• Tetanus toxoid
• Diphtheria toxoid
• Hepatitis B vaccines

Although Novavax took part in Operation Warp Speed, the company had not brought a vaccine to market before. The company experienced challenges scaling up the vaccine for manufacturing, which, according to Moss, was still an obstacle in June 2022.

While BioNTech partnered with Pfizer to access the manufacturing and distribution chain for the Pfizer-BioNTech vaccine, Novavax only recently partnered with the Serum Institute of India, the world's largest vaccine manufacturer.

There was also a delay from the FDA advisory group to the FDA EUA as they investigated the manufacturing process.

How Does Novavax Differ From Other COVID-19 Vaccines?

The main way Novavax differs from other COVID-19 vaccines is in the technology used in the vaccine. Novavax uses older technology than the Pfizer, Moderna, and Johnson & Johnson (J&J) vaccines.

The Novavax COVID vaccine does not use technology that impacts your cellular RNA or DNA. Instead, it uses a protein to trigger an immune response in the body.

There were three other vaccines with EUA approval when the Novavax Adjuvanted vaccine received EUA approval. In the U.S., two vaccines use messenger RNA technology. A third uses adenovirus vector technology.

mRNA Vaccine Technology

According to the National Human Genome Research Institute, your body uses mRNA to build amino acids into a protein inside the nucleus of a cell. The mRNA carries the information; RNA polymerase transcribes it and translates it into a protein chain. 

This code tells your body to produce the protein that your body then recognizes as the virus. This protein triggers an immune response that your body should recognize when it contacts the SARS-CoV-2 virus as a foreign body. 

Adenovirus Vector Technology

The technology used in the J&J vaccine is based on a modified virus called a vector virus. It cannot reproduce itself. This instructs the body's cells to mount an immune response.

According to Centers for Disease Control and Prevention (CDC) recommendations, this vaccine should be considered only in a limited number of cases due to a link to a rare but serious condition called thrombosis with thrombocytopenia syndrome. 

In April 2021, the government paused the distribution and administration of the J&J vaccine for 10 days. This was to investigate cases of blood clots that occurred within two weeks of the vaccine. After determining that the benefits outweigh the risks, federal officials approved resuming its use.

Is Novavax Effective Against Omicron and Its Subvariants?

The company reported 90% efficacy against mild, moderate, and severe diseases. The trial involving 30,000 participants was conducted before the delta and omicron variants were circulating. 

At this time, it is uncertain how the vaccine will perform against SARS-CoV-2 variants or subvariants. However, according to one report, the company has since tested the vaccine against omicron and the newest variants. The FDA scientific advisors called the preliminary evidence compelling. 

Who Can Get the Novavax Vaccine?

The July 2022 FDA EUA approves the Novavax vaccine for individuals 18 years and older. Although the FDA approved it, the federal government is warning that the shots will be in limited supply. 

According to the CDC operational planning guide, there will be a limited number distributed, and not all vaccine providers will have it. In total, the first shipments will include about three million doses. In the first months, it is unclear which providers will have access to the Novavax COVID vaccine.

However, as the distribution ramps up, it is expected that you will be able to get the Novavax shot anywhere that you can currently receive the Pfizer or Moderna shots, including your local pharmacy.

What Are the Side Effects of the Novavax COVID-19 Vaccine?

The typical side effects reported include:

• Arm pain and fatigue
• Headache
• Nausea or vomiting
• Pain at the injection site
• Muscle pain
• Fatigue 

The FDA also warned there is a possibility for myocarditis or pericarditis, also found with the Pfizer and Moderna vaccines.

Symptoms of heart inflammation typically begin within 10 days of receiving the shot. Recipients should seek immediate medical attention for symptoms that include:

• Chest pain
• Fast-beating or pounding heart
• Shortness of breath

Novavax also reported a risk of allergic reaction to the vaccine and moved from calling these "important potential risks" to "important identified risks." However, after the FDA authorized the shots, Dr. Peter Marks said the vaccine met the FDA's high standards for "safety and effectiveness for emergency use authorization."